My Ultrasound work Around the world in 35 years

 

Many of us have traveled the world for business or tourism.Some travel for work.

Many of you met famous people and saw different cultures. USA, CANADA, AUSTRALIA,  ASIA, MIDDLE EAST, JAPAN, KOREA, CHINA, I had the opportunity to visit and work and so many cities and countries around the world.These are some of the places that I visited and some of the people that I worked with or di an ultrasound for. I started from Lebanon, Baghdad, Germany, Greece, then Canada east to west, USA, Saudi Arabia west and east, Brunei, Australia, Japan, South Korea and Back to Canada I lived and worked in  (North Ontario , Windsor, London ,Hamilton, Manitoba, Saskatoon, North BC and Vancouver, North Alberta , and Calgary.        

 

                                30 min from my place  in Okotoks- Alberta              

                                                              

 King Faisal of Iraq palace where My father used to work.  

 visited and worked in Baghdad.When it was a peaceful secular country with No fanatics and lunatics.

 Baghdad was Modern until it follows the communists and Iran influence. 

 The famous Lebanese poet Nazar Al  Qabani, I did an X-Ray on Him back in  1975.

  King Hassan Al Bolkiah, Sultan of  Brunei. Ultrasound him twice 1992 and 1999.

  He is the greatest person I ever worked for. 

 Our  Boss, Prince Jeffry Bolkiah, performing when I was working at Jerodung Park royal medical Center in Brunei from 1994  to 1999.

 One of Tina Turner performing in Brunei injured her right groin so they rushed her to the ultrasound to r/o appendicitis, she had a muscular tear.I did us when I was in Brunei.I was watching Tina Turner. 

 Babylon 50 mile from my place visited at least 4 times a year. Until I left the country.

 Greece, Santorini island

Visited so many times in the summer when I was living and working in Athens.I was working at the red cross hospital in Athens 1979. 

 Dr. Ted Lyons, Our Boss back in 1983.

We learn how to ultrasound using contact scanners. He still the director of the diagnostic department in Health science center, Winnipeg, Manitoba. 

Dr. Co0per Berg, The best Radiologist I ever met and listened to his lectures. In Vancouver. 1987

 BOB HOPE

 Leslie Townes Hope, Born in London,  UK- May 29, 1903. Passed away July 27, 2033. Toluca, California did an abdominal ultrasound on him in Palm spring California when he used to visit his friends and play golf with my Boss.He came on the weekend, we opened the clinic for him and my boss asked us not to take pictures etc.He was a charming and respectful man. 

 Betty White Ludden, known professionally as Betty White, is an American actress, comedienne, author, producer, radio host, singer, and television personality.

Born  January 17, 1922, Oak Park, you, Illinois, USA. My Boss and I visited her while she was in Palmspring, California. When she met us at the door she asked me after my Boss Introduce me ; ( Hi,  Do you smoke, I said NO. Good for you, she said. I asked my boss why she asked this question. He said she doesn’t like anybody smoke in her place and If you do want to smoke you have to go 2 blocks from the house.  

 Chaz Salvatore Bono is an American advocate, writer, and musician. He is the only child of American entertainers Sonny and Cher. Bono is a transgender man. Born March 4, 1969 (age 46), LA,California..Full name was  Chastity Suni Bono. His father Suni Bono was our mayor in palm spring Californian before he died. They brought Chastity to our clinic for an ultrasound.I was the one who did the Ultrasound with the presence of Soni Bono and Cher. She was 17 years old. 

The Brunei Royal family 

With so many VIP Visitors from many parts of the world used to come to our royal Medical center.

Prince Hakeem. Ultrasound him once

prince Jefri, I ultrasound many times, including Cardio sonogram, etc. For annual checkup.

Crown Prince Haji Al-Muhtadee Billah Ibni Sultan Haji Hassanal Bolkiah. He will be the next King. I ultrasound his Eye with Doppler. Twice, one of the best Gentleman, soft-spoken, smart man I ever met.

Ultrasound him in Brunei, Royal clinic.  

 

 Crown Prince Haji Al-Muhtadee Billah Ibni Sultan Haji Hassanal Bolkiah

 Prince Safri and his wife. I ultrasound them both. in the Brunei royal clinic.

Micheal Jackson with one of the Royal family In Brunei he and Janet used to sing in BRUNEI.I attended Janet Jackson concert but not Micheal.   

 King Fahad of Saudi Arabia, He was in Jeddah Palace back in 1999 and had a problem, Our Hospital  King Fahad military Hospital was the closest, My Boss the Radiologist Dr. Zammit and my self-went to the Palace to do an Ultrasound and we took the Machine with us. We managed to meet him and did some work and then he was lifted to Riyadh. God bless him he was a very nice man.  

 When i was working in California back in 1986, I was volunteering my time on the weekend to work with the vets to do Animal  sonography,

 I managed to ultrasound A Gorilla, after sedation, of course, looking for liver hydatid cysts.

 (1960) Sculptor done by famous Iraq Artist, Jawad Salim, a pioneering Iraqi artist who died prematurely at the age of 41, He did the sketches and my father managed to put the art together and work with him to adjust and cut the pieces. 

Mykonos island in Greece, I used to visit and work in the summer.One the best island I ever lived in.

Νοσοκομείο Ερυθρός Σταυρός

 The red cross hospital in Athens where I used to work Before migrating to Canada 1979. 

I was working in as an X-Ray technician IN DUSSELDORF.

   Love Berlin, I was deported from this city because I used to work without working Visa.  

Singapore best clean city I ever visited while I was working in Brunei.I managed to see Malaysia and Indonesia islands.

 King Fahad specialist hospital In Dammam one of the best Hospital, and the best staff. Many Saudi who Graduated overseas run the hospital.  Bader AL  Nasser was The director, one of the best-educated man I ever work for. But the ultrasound staff and supervisor are not registered and not well qualified and make life difficult to western graduates she is a Pakistani doctor turn sonographer and she still working in that region she the worst nightmare to anyone working with here and almost got fired but some Arabs doctors helped her out to stay she lied and faslified information about saudi workers nd many others who are hired , she is the worse muslim you will ever meet.

I used to live and work in London, Ontario and went to Fanshawe college radiology department. 

1981 1983

 Manitoba 1984 . Ultrasound diploma.

My BSC IN Diagnostic  Imaging,  

and MSc IN Medical Ultrasound from Charles Sturt University. Waga- Waga campus, Australia 

I was working in high-level Alberta for 7 years. I ultrasound almost 50 % of the town including the mayor. one of my friend Scot IN the green shirt Is the top Counselor now…way to go Scot.

 King Faisal of Iraq. My dad used to work for his family and paint portrait pictures for them and his family and landed my dad in prison later because of it.when I was young I witnessed the killing of his family while the Iraqi Barbarians hanged all his family and display their bodies in the street for people to watch. And this King actually the true descended of the prophet. 

Moose Factory, North Ontario I was doing X-Ray and Ultrasound back in 1984 

 It was cold in winter 

 Mose factory general hospital

 Now called; Weeneebayko Area Health Authority

 

I was working in Jeddah close to the red sea. one of the best spot ever. but it was so hot and humid in the summer. 

 

Our previous Mayor of palm spring California Sonny Bono and his wife then Cher. I ultrasound him and his daughter. 

Lived and worked in Windsor Ontario.

I started here.  

  Some of the greatest people that I worked for and with;  Dr haddock, Dr. Watt grandson of James Watt. Denise Graton, Merle Mc Cay, Cooper Berg, Goldberg,

Gary Kocher, Dean McMillan, Dr. PLATT, Ortho talk group in the USA. Dr. George Lipold. Dr. Hanson, Dr. MacDonald, and many other Radiologists in Germany, Greece, Middle East, USA, Canada, Australia, and South East Asia.Among them the best CEO and founder of the Royal Brunei Clinic Dr. Essam Shaaban, Sports Medicine specialist from France. Everyone contributed to our successes and achievement. LIFE IS A JOURNEY.

Ultrasound advancement improving the quality of patient care around the world. ( Review of My ultrasound work in different countries, provinces and cities with some literature reviews).

 Abstract

As portability and durability of ultrasound machines are improved, the bed side clinician-performed ultrasound is increasing. We are seeing increasing use of ultrasound procedures in rural, develop and underdeveloped parts of the world by doctors, midwives and trained nurses.

Physicians, nurses,  midwives, and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams.

I worked in different countries, lectured, presented cases, and did some cross training in so many overseas countries ,provinces and cities from 1975 until now ,including ;The USA , Canada , Middleast, Germany, Holland, Greece, Australia, Japan, South Korea, Singapore, Brunei, Malaysia , Indonesia, and Magnolia, anywhere between few week to few years as radiographer and sonographer. I had the opportunity to Ultrasound kings and queens, and members of royal families in Saudi Arabia, Brunei, Malaysia, and Jordan.

 ultrasound use in the developing world and training guidelines currently in use, and highlight indications for emergency ultrasound in the developing world. More training and teaching of staff who practice sonography is important for bedside ultrasound use, and more research is needed it to improve the diagnostic capacity and patient care in the most remote areas of the globe. Sonographers are encouraged to seek work in different part of the world to cross train and pass the sonography skill need it in many parts of the world, working in different culture and experiencing a different way of doing the task each day. You can use your skills to teach and gain new information while working overseas a courier is a rewarding that can benefit both you and the community you serve.

 Background

I started my ultrasound courier right after graduation from Winnipeg health science center in1984.

I was working in the north part of Ontario, in moose factory.

I start working in Windsor Ontario-1984 to 1987, Reno Nevada, Palm Desert, and Indio California- USA, 1987, North BC covering terrace, Kitimat. Abbotsford -BC, and Vancouver –BC until 1991.

Saudi Arabia Hhofuf region- Alhasa, Khobar, and Dammam region 1992 to 1994, Jeddah region, in different time of my courier, Also covered Greece, Germany, Holland, Lebanon, Turkey, and Iraq from 1975 to 1979 doing Radiology. Moved to Brunei in 1994, and did some cross training and lectures in Singapore, Malaysia and Indonesia ( south east ), Magnolia, Japan, and South Korea.

Did my echocardiography in Australia and worked in some clinics. Also Worked in Saskatoon, North Alberta High level, and surrounding cities.And moved to Calgary 2010.

 I gathered so many facts and ideas, talked to so many sonographers from a different part of the world and saw how they do the ultrasound task and handle daily problems, and witness the change of ultrasound technology from the contact scan era, mechanical transducers to the present day ultrasound machines.  Also, witness the improvement of the Radiologists and sonographers in regards to ultrasound educational progress and learning methods.

It was a most wonderful experience to work with different people and culture and be part of this global ultrasound and the diagnostic health provider community.

In addition, I witness that machine design has become more user-friendly, compact, smaller and affordable With fewer knobs and streamlined design for quick comprehension of key features.

Many new laptop-based machines are now in production. Improvements in battery life for hand-carried

machines, and the lack of film, chemical developers, and dedicated technicians allow for use of ultrasound in health missions to remote areas of the developing world. Because of this evolution in technology and the growing body of literature to support its use, ultrasound has gained increasing recognition as a valuable diagnostic tool for resource-limited settings by the ministries of health in different countries I visited, and by the world health organization -united nation.

 Moose factory, North Ontario 1983

Moose Factory hospitals experience increasing number of self-inflicted trauma volumes in that region, we used to have limited ultrasound capabilities, with ATL 2, leading to significant diagnostic and therapeutic 

Challenges, as I used to use a saline bag to scan the thyroid and other small parts, due to the limitation of small part transducers.They had a high number of frost bites and fingers imputations due to alcohol use and falling sleep outside on the street in a minus 40-degree temperature. A high number of TB, fatty liver disease among men, and increasing PID and STD among teens with notable ectopic pregnancies.

The community was ruff and difficult to work for, with lots of stabbing, alcohol, and depression.

Windsor, Ontario, 1984 -1987

I was working for Windsor regional hospital , it used to be called IOD hospital back then In 1984, The Diagnostic department used to have a contact scanner machine, an old version of a mode scanner, ATL us early generation machine with mechanical transducer and a Doppler machine that I used to do arterial Doppler depend on sound only with no imagine , so I used to listen and grade the stenosis depending on hearing only.

 A high number of pancreatic cancer, renal cancer, and testicular cancer was diagnosed.Among it Thyroid tissue in dermoid masses in a lady with thyroidectomy. I started my shoulder ultrasound training with David MacDonald and I was providing shoulder ultrasound scanning since 1984. 

Reno Nevada- USA, Palm Desert and Indio California 1987- 1989

We were spoiled, as we use to have an old version of Acuson us the machine, it was considered The Mercedes of us machine in that time. We had So many depression and stressful patients, and Reno had The highest suicide in the USA per capita in that time.

While in Indio California they live longer than other areas in that region. Most of our patients were Mexican immigrants, and in palm desert California most of our patients are VIP and other rich people. I had the opportunity to scan Bob Hope, Sonny Bono the mayor of palm desert, Betty White, and others. I noticed Lots of gallstones and renal stones among the Mexican population due to hard work under the sun and dehydration. I also was lucky to volunteer for the Sandiego zoo to assist the vet in scanning a gorilla liver , for abscess and Hydatid cysts.

North and south BC, Canada, 1989-1991

Covering Terrace, Kitimat, Abbotsford, and other private clinics in Vancouver.

The weather was a bonus, salary level is low and tax is higher than Alberta.

It was hard to find a full-time job, as many departments and clinics try to avoid paying benefits In that time.

 Lebanon, Syria, Iraq, Egypt, and Morocco

You will not find many of these problems if you decide to go to Lebanon, Syria, Iraq, Morocco, and Egypt in those days.Each country has a different culture, different pay scale, and they are much open mind than the Gulf states when it comes to western workers. They do speak English and French to some degree.

And If you done all your paper works, established your connection, and routine, then you can enjoy the new and different culture, great food and gain weight.They use Lira, Dinar, Jeneh, instead of riyal and dirham. You can Google for Geography, history, and currency of each country before you decide to visit or find work. If you have a friend who knows a local family or someone local it will be a great help to start your journey. Many Canadians end up meeting their future significant other and got married.

I was working in Al Hofuf –AL Hasa, south-east Saudi Arabia Region. I worked in this region from 1992 to 1994, ultrasound was introduced at Many rural district hospitals, and clinics, and the impact on patient care was assessed by asking providers to identify if ultrasound changed patient management plans. And the answer was positive. In those days we didn’t have Pac or digital system.

The majority of scans were performed for obstetrical purposes and 80% of patients always ask for the female sonographer, for cultural reason, 20% of patients don’t mind male sonographers.

 Many fetal malformations were noted due to the restricted genetic pools in that community due to the close relative marriages among that Shia minority, some of the fetal anomalies include anencephaly, fetal cardiac and brain anomalies and uterine malformations. High Cholesterol and obesity now is an epidemic in Saudi and Gulf states countries followed by diabetes, and it makes it more challenging to do the abdominal ultrasound.

while most male patients were sent for abdominal and small part sonography, renal us was an on top of the list, as there was an increasing number of renal disease and malformations, stones and other renal pathology in that desert community.

Male and Female sonographers

Female sonographers are in high demands in most of the Muslim populated areas of the Gulf states, Saudi.It is very difficult nowadays for a male sonographer to get a job in Saudi, only if he is Saudi Citizen, or if you get hired as a supervisor.

Restriction, and work environment in Saudi Arabia.

There are many restrictions if you decide to work in Saudi Arabia, with 50% turnover staff from western countries, some leave and quit in 2 weeks time, some last less than 3 months, due to a cultural shock, hot temperature and high humidity, restriction on travel, parties, and driving.

Many of the Gulf states countries have dress codes, don’t tolerate alcohol, immodesty in beach areas, especially in Saudi Arabia was parties are not allowed if you don’t ask for permission first.

They don’t allow women to drive in Saudi yet, and for men, it will take a long time to get your license,  cell phone, and the internet if you don’t have all your paperwork in order.

 Pets and cargo

Don’t take your pets even if they allowed you, it is the most shocking experience for the pets I ever experience. my 3 cats almost died and I managed to save them in the last minute with the help of a local vet. It cost me 5000 dollars for 3 cats cargo, vet papers, health documentation, and embassy approval.

Don’t ship your cargo to Saudi Arabia, or TO some Gulf states, it will take you up to 3 months to get your cargo back and you spend more money than the cargo amount to obtain all the paperwork’s, inspections, X-ray of the cargo, and transportation. You also need some bribery money, to get what’s belong to you! I had to bribe an officer and lower rank guard to get my paperwork, then you have to pay almost 2000 dollars to have someone from the country to go and act as a middleman to do all the paper for you. The country do this so they can make money and creates jobs. So it is more bureaucracy for us and more money for them.

It is easier in the United Arab Emirates, Bahrain and Kuwait when it comes to driving, shipping and obtaining social media etc. Qatar almost like Saudi too.

Don’t think you are going to save money, as you will end paying so many fees for so many documentations and registrations, utilities pay phone bills, and you will spend more on-site seen and traveling.

Most of the goods and items that you take for granted here are very expensive in Saudi. Don’t ever take Alcohol or any candies or chocolate with alcohol in it, the same thing goes for Brunei and other Muslim countries. You are allowed to get some ration from your Embassy, or at Aramco site and other international organization who have a license and permission to do so.

Some Saudi people go to Dubai, Bahrain, and Kuwait to more free lifestyle in bars, movies, dance clubs and beech with mix gender if they are close to the eastern region, while those who live close to the western region they used to go to Egypt, Lebanon and Syria for more fun. Those who can afford it they fly to Europe. Most of the workplaces in Saudi are separated to male and female segregated rooms, lounge, etc. You feel like you are living in an open prison.

Don’t believe what they tell you or what they offer you. Negotiate for more and you will get it if the demand is high.

Try to ask for a locum job first, so you can have a chance to see the workplace and make your mind before you bring your wife and kids, pets and cargo. It will take you less than 3 weeks to find out the facts.Most Asians, Middle East, and African workers can tolerate heat, humidity, Saudi harsh weather, and work condition, but not so when you come from the western cool country.

Don’t ever leave before you done all your paperwork’s, otherwise you end up suffering for more than 90 days before you can get your documentation, in order for you to get cell phone connection, and other social media technology etc. Many western technologists leave and never go back in the first few weeks.Some left all their belonging behind just to get rid of the bureaucracy and the harsh environment.

 That’s why Saudi Arabia now makes It even more difficult for you to leave. You have to do the release form and that can take you up to 2 weeks.From the moment you enter to the moment you leave the country you are a suspect , and when you decide to leave or resign, you have to do the paper trail for the relies form, almost 25 different stamps from each department to clear you , and so many signatures from the lower to the higher manager ,director, and security to release you.

You keep running between departments that are in different building and streets in the 40-degrees heat and every time you think you reach the department you will find it closed down for lunch, tea break, prayer time etc.

Same goes with the banks if you don’t have your papers in order, forget to open an account in any bank or send money anywhere. So bureaucracy is at large.

You will have so many problems from the time you arrive at the airport, to the time you leave. Many people don’t go back after they take a vacation, and those who go back they notice an increased level of depression, stress, and anxiety. Your recruiter will not tell you all the truth.

Sleeping and noise ; In Saudi Arabia your sleeping pattern will be changed in the first 3 months, as you have to adjust yourself to the heat and humidity , constant air con to cool down, and drinking lots of water there for going to washroom in the middle of the night , and if that wasn’t enough the call for the prayers 5 times a day with lower speakers everywhere, and almost at 4 am will take those early hour of beauty sleep from you .

So when you wake up to go to work you look like a porcupine on steroids, so think twice before you decide to go to Saudi. I went to Saudi 3 times, Onlyand every time I said to myself never again, cause I trusted my recruit the only exception I make is if you work with Aramco oil company, As it is Run mostly by USA and western companies and the hospital follow North American protocols, and it has more friendly work environment

Jeddah, 1999

I was working in Jeddah in the west part of Saudi Arabia back in July 1999.It is much better working condition than east part of the country, close to red seas, benches more fun and relaxed people, with more opportunity to go to beaches, easy access to travel.But it can be very busy place as it is the place where millions of people fly to hajj and go to Mecca throw Jeddah airport.

.In Jeddah I also noticed an increasing number of Renal disease, and kidney stones . while the eastern part of Saudi in Dammam and Khobar I noticed more renal disease than the western part of Saudi and more fetal malformation, liver tumors. And chest disease.

The number of Cataract eye diseases was high in Eastern Saudi Arabia as I was doing ophthalmology sonography once a week, with the ophthalmology department. I had the opportunity to scan many royal family members and get the experience of going to the palace of the king and his family along with our radiologist.

Trauma ultrasound; Lebanon and MiddleEastFAST (Focused Assessment with Sonography in Trauma), has been used routinely in the management of trauma patients worldwide as a rapid, noninvasive way to evaluate patients with thoracoabdominal trauma. The FAST scan can be performed within minutes at the bedside and can help in resource-limited settings with decisions regarding which patients require immediate operative care.

The FAST exam has been shown to decrease the time to operative intervention in a randomized controlled trial as compared to a standard clinical evaluation.

Patients that received FAST had a 64% decrease in the time to operative intervention and decreased complication rates and hospital length of stay [30]. The sensitivity of FAST scans in detecting intraperitoneal hemorrhage is 75-78% and its specificity is 98-100%, suggesting it is a useful tool to confirm the presence of hemoperitoneum and hemopericardium [31,32].

Clinically, the FAST scan is particularly beneficial in the hypotensive trauma patient whose source of hypotension is unclear [33]. In addition to its use in resource-limited settings during routine clinical care, FAST is also useful in disasters and mass casualty scenarios.

When evaluating multiple severely injured patients in a disaster setting, FAST can aid in rapid triage of injured patients and guide operative care. For example, FAST during wartime in Lebanon was employed as a tool for soldiers suspected of having abdominal injuries to help triage them to operative intervention, computed tomography (CT) or clinical observation [34].

FAST has also been used by medical relief workers during multiple natural disasters in the past 2 decades, including the earthquake in Armenia in 1988 [35], Wenchuan, China, in 2008 [36], and Haiti in 2010

[37], and the tsunami in Indonesia in 2004 [38]. FAST is also valuable in a resource-limited setting where there is limited access to computed tomography.

Brunei and south-east Asia

I Start working In Sultanate of Brunei FROM 1994 to 1999,  for the Jerudong royal family medical center was located on the south china sea sandwiched between Sabah to the north and Sarawak

To the south Part of Malaysia, and west of Borneo Island of Indonesia.

The medical center was for the Royal family only along with the VIP, Ambassadors, with 95% western staff. I was the ultrasound supervisor, as we had to go 2 weeks butler school training for conducting our self in the presence of royal family, dress code and other manors were extremely important to obtain your job. 

The country used to be more relaxed in that time with some restriction when it comes to alcohol, women can drive and you can leave the country and cross the border any time you want as long as you have your valid passport with you. They use Bruneian dollar, No tax, free housing, free 2 trips a year and educational leave and many other benefits and bonuses. You expected to be on site when your service is needed it and sometimes you stay until dawn waiting for the Royals, and then you have to come back to work at 8 am. It was a wonderful life and work environment back then until 1999 when the country had some financial problems and the place was shut down.

Ultrasound machines used in South East Asia.

south-east Asia uses many different ultrasound machines and the major suppliers are Japan and Australia as it is closer and operate with the country with a heavy presence, ultrasound machines such as; Toshiba ( Japan ), Diasonic ( Australia), Vingmed

( Swedish), and many other machines such as Aloka, Accuvix, Medison, Sonos, Shimadzu, and Hitachi. Driving is the same as in the UK.People are more friendly and helpful.You must visit Singapore, working in Singapore is difficult as the salary is less than Brunei

With expensive car insurance and high rent, but you can get your PR while working in Singapore for 2 years or more. Japan in other hand is more expensive than all south-east Asian countries the people are the most polite people in the face of this earth, with much advance ultrasound machines and skills, the only problem is they have difficulty in speaking English.

South Korea is Second to Japan when it comes to the ultrasound advancement and skilled sonographers and one of the best in that region. Japanese have mild temper compare to South Korea in the rush hour traffic.

I presented Brunei when I got selected in Japan to present my research back in 1998, With the international radiological society, the minister of health and education attended the convention and they take a high bride of supporting education and research.

Saskatchewan

I was working from the end of 1999 to end of 2002.In Saskatoon Royal University Hospital,27 dollars an hour doing 20 patients a day

The Salary was a jock but the experience was great, we have a wonderful supervisor Gary Kutcher and good staff radiologists and they taught us to allot of MSK and Vascular ultrasound skills. The weather was harsh in winter and I leave if to that. Salary now in the scale of 47 dollars an hour maximum in a hospital setting.

North Alberta- High level

It is the last city north of Alberta, 3 hours from NWT.I start working in high-level hospital from Jan 2003 to Jan 2010.

I served 26,000 people with one ultrasound machine for 7 years, covering

High level, john-dor, fox- lake, Lacrete, Zama, Garden River, meander river, Fort Vermilion and many other small towns. With mix community of Native Indians, and Mennonite is more visible.The hospital belonged to AHS when Alberta was divided into 9 health region, I left the hospital when AHS took over the province health system and made it one region there for cutting bonuses and

Makes it difficult to barging for high salary etc. I noted increasing number of testicular cancer, Liver cancer among the white population. Uterine malformation and renal malformation among the Lacrete population. Fatty liver infiltration, gallstones, TB, std, and Pid among the teens of native Indians population.

Cardiac ultrasound

Focused echocardiography has an important role in assessing patients with cardiovascular compromise. It is useful in diagnosing pericardial effusion, assessing left ventricular ejection fraction, assessing volume status in patients with shock and delineating the etiology of cardiovascular collapse. In one study in the US evaluating patients with dyspnea of unclear etiology (i.e., after ruling out congestive heart failure, pneumonia, COPD, pulmonary embolism), pericardial effusion was found in 13.6% of patients [45].

The incidence of such effusions may be higher in communities where HIV and tuberculosis are

more prevalent. Research supports the ability of non-cardiologist physicians to accurately diagnose pericardial effusions. In a large study evaluating 515 high-risk patients with dyspnea, 103 had a pericardial effusion. EPs’ bedside echocardiography obtained the diagnosis

with a sensitivity and specificity of 96% and 98%, respectively [46].

Evaluating for deep vein thrombosis (DVT) is useful in patients with leg swelling/pain, crush injuries, prolonged immobilization, recent surgery and other pertinent risk factors. In resource-limited settings, due to the hypercoagulability of HIV-positive patients and the lack of routine prophylactic anticoagulation of hospitalized patients, bedside diagnosis of DVT is especially important in providing timely care. Ultrasound evaluation for DVT has-been shown to be successful by non-vascular specialists

ranging from novice to advanced users of ultrasound, and can be performed in just a few minutes at the patient’s bedside [54,55].

Procedural ultrasound

Obtaining peripheral venous access can be a challenge in any setting in patients with obesity, vasculopathy, hypovolemia/ dehydration or history of intravenous drug use. In patients where the traditional approach has failed, ultrasound can be used to visualize a target vein. Physicians

have demonstrated a success rate of 91- 97% of a decreased time to cannulation and improved patient

satisfaction, and a very low risk of accidental arterial puncture [67,68]. Nurses and technicians trained in this technique have demonstrated an 87% and 78.5% success rate, respectively [69,70].

developing world and rates of death from nearly all types of injuries are higher in developing countries than undeveloped countries [76,77]. However, in resource-limited settings, the availability of blood for transfusion is likely to be limited, and the blood that is available may not be comprehensively

screened for infectious diseases such as HIV or hepatitis B. Therefore, it becomes incredibly important

to have an accurate estimate of blood loss in both trauma patients and obstetric patients in order to ensure that those who truly need life-saving blood transfusions get them rapidly, but precious and potentially dangerous blood transfusions are only used when absolutely necessary. However, blood loss in both obstetric and trauma patients may be difficult to assess clinically. Patients may not develop supine or even postural tachycardia or hypo-tension until they have lost a significant amount of blood volume [78].

Dehydration

Dehydration due to diarrhea is one of the leading causes of death in children under 5 in the developing world, responsible for nearly 2 million deaths (19% of all child deaths) each year [86]. In addition, epidemic diarrhea can kill thousands of children and adults in a matter of days or weeks in the setting of disasters and humanitarian emergencies, as evidenced by the recent cholera epidemic

in Haiti. As the severity of diarrhea can vary widely in these settings, accurately assessing dehydration status remains a crucial step in preventing mortality from this disease. While patients with severe dehydration require immediate treatment with intravenous fluids to prevent hemodynamic compromise, organ ischemia, and death, a large meta-analysis found that children with mild to moderate dehydration have a significant reduction in hospital length of stay and fewer adverse events when treated with relatively inexpensive oral rehydration solution (ORS) as compared to treatment with costly intravenous fluids [87]. Unfortunately, the diagnostic tools available to physicians and other providers to assess the

degree of dehydration in children with diarrhea is limited. A recent meta-analysis of 13 studies found that no individual clinical sign or symptom demonstrated adequate sensitivity, specificity or reliability for detecting dehydration in children [88]. A similar meta-analysis of adults found clinical measures of dehydration to be even less useful [78].

Ultrasound may be a better measure of dehydration in patients with acute diarrhea. In children, since the size of the IVC varies with age, research is currently focusing on the aorta to IVC ratio as a measure of volume status; the aorta provides an internal control for IVC since it does not change much in size with dehydration. In a recently published study of 52 children presenting to hospitals in rural Rwanda with diarrhea and/or vomiting, the aorta/IVC ratio had an area under the Sippel et al. International Journal of Emergency Medicine 2011, 4:72 http://www.intjem.com/content/4/1/72 Page 8 of 11

Edema in children

Edema is a common presenting complaint among children in low-income countries. It can be due to hypovolemia, such as in the settings of congestive heart failure secondary to rheumatic heart disease or renal insufficiency, or it can be due to low oncotic pressure from a nephrotic syndrome or protein-energy malnutrition (kwashiorkor). Indeed, patients with severe protein-energy malnutrition may appear edematous at the same time as they are actually intramuscular dehydrated, making it difficult to adequately assess their volume status on physical exam. Two studies from pediatric nephrology clinics in Poland and Israel suggest that ultrasound of the IVC may be useful for differentiating hypervolemia from edema secondary to low oncotic pressure, which could prove useful in guiding further diagnostic testing and management of patients in resource-limited settings.

Cerebral malaria

Novel research from the pediatric acute care unit of Mulago Hospital in Kampala, Uganda, shows an ultrasound of the optic nerve sheath diameter (ONSD) may be predictive of cerebral malaria in children. In this study, 33 children diagnosed with P. falciparum underwent targeted ultrasound examinations of optic nerve sheath diameter, color transcranial Doppler insonation of the cerebral vasculature, cardiac ultrasound, and abdominal ultrasound to evaluate spleen size. Increased optic nerve sheath diameter was observed in one-third of all patients with malaria and in 100% of the patients with cerebral malaria, and after successful treatment showed return to normal size [8].

Conclusions

Trained nurses, midwives, and Clinician-performed bedside Ultrasonography is emerging as a useful diagnostic tool for healthcare providers in resource-limited settings.

Much of the research to date supports the use of this technology to guide management plans and procedures; however, comprehensive, long-term studies have not been performed.

As further research emerges to evaluate the impact of ultrasound in resource-limited settings it will be possible to draw conclusions about the long-term sustainability of ultrasound programs in the developing world, target populations who may benefit most from ultrasound services, and further expand the indications for its use.

More training and teaching of staff who practice sonography is important for bedside ultrasound use, and more research is needed it to improve the diagnostic capacity and patient care in the most remote areas of the globe. Sonographers are encouraged to seek work in different part of the world to cross train and pass the sonography skill need it in many parts of the world, working in different culture and experiencing a different way of doing the task each day.

You can use your skills to teach and gain new information while working overseas, it is a rewarding career that can benefit both you and the community you serve. We must be flexible tolerant and understanding individual when working in a different work environment with different people and culture. The improvement in ultrasound technology is helping to provide the sonographers and doctors with faster diagnosis, better imaging capability with affordable budget. 

Thank you for reading;  Steve Ramsey, Ph.D.-  Calgary, Alberta- Canada.

Now I am wroking with ADC – Diagnostic centre in Calgary , Alberta 

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